Provider Demographics
NPI:1720013543
Name:GOODYEAR, CATHERINE WALTER (PA-C)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:WALTER
Last Name:GOODYEAR
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0360
Mailing Address - Country:US
Mailing Address - Phone:888-339-6065
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:4740 COMMERCIAL PARK CT
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9387
Practice Address - Country:US
Practice Address - Phone:336-245-9521
Practice Address - Fax:855-308-2340
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1720013543Medicaid
NCQ00972340OtherRAILROAD MEDICARE
NCNA3809AOtherMEDICARE
NC2064JOtherBCBS NC